Unknown Individual – Vascular & Interventional Radiology Physician, NPI 1205808011

Unknown Individual is a healthcare provider. based in Montgomery, Alabama. specializing in Vascular & Interventional Radiology Physician. They hold a License No. 00005091 (AL). The NPI Number for Unknown Individual is 1205808011

Main info

Organization
Inactive
63 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1205808011
Phone
(334) 269-6337
Address
2055 NORMANDIE DR
Deactivation Date
1 October 2021

Doctor Profile

Medical School Name
UNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
Secondary Phone
3342894000
Graduation Year
1963 (63 years ago)
PAC ID
5799771176
Group Practice PAC ID
3870497720
Professional Enrollment ID
I20040421001529
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 2055, Normandie Drive, Powelldale, Montgomery, Montgomery County, Alabama, 36111, United States

    108

    MONTGOMERY, AL 361112732

    Phone: (334) 269-6337

    Fax: (334) 834-0657

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 36111)

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Provider's Procedures

Unknown Individual performs procedures in Vascular & Interventional Radiology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DIAGNOSTIC RADIOLOGYAL71250CT scan chest2524
DIAGNOSTIC RADIOLOGYAL74177CT scan of abdomen and pelvis with contrast1818

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3870497720View full group profile
NameSpecialtyState
-AL
Diagnostic RadiologyAL
Diagnostic Radiology, Interventional RadiologyAL
Diagnostic RadiologyAL
-AL
Diagnostic RadiologyAL
-AL
Diagnostic RadiologyCA
Diagnostic RadiologyRI
-AL

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1205808011.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Vascular & Interventional Radiology Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Montgomery, Alabama in the data we show; additional addresses may exist on the full record.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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